hi dr lederiechi wonder if this catagory was there so that we can get some advice from a profetional so here goes.i wanted to ask your advice to see if there is any connections between two symptoms.after my daughter was born about 5 years ago i found out that i have a slow thyroid so i was put on a medicaition to help stabulize it. shortly after that i started getting symptoms of panic attacks.wich i get every singal month like clock wise the symptoms are more phisycal then emoutianal.for egzample i feel presure in my head over my eyes i feel dizzy and sometimes see double for a minute till it is over . i am wondering if they may be a connection between the thyroid and what i am feeling like panic attacks . and what type of a doctor should i be seeng about is

Hi = You stated that postpartum you were diagnosed with a "slow thyroid" - hypothyroidism.You were put on medication - good!

But unfortunately, you noted panic attacks which you get monthly, with mostly physical symptoms.The symptoms include feeling a pressure in your head above your eyes, and feeling dizzy. Eachepisode lasts for about one minute.

You ask if there is a connection between the panic attacks and the thyroid?You also ask what kind of doctor should you see?------------------People who have thyroid abnormalities - either a too active thyroid (hyperthyroidism), or iftheir levels of thyroid replacement hormone (functionally hyperthyroid), can have symptoms of nervousness.You need to make sure that your thyroid hormone level in your blood is not too high or too low.A good place to start with your "work up" is your primary doctor, who would do a complele historyand physical, would also check the level of the thyroid level in your blood and adjust yourmedication accordingly.

If this does not work, I would consider going to a neurologist to help make sure this is not a neurological event. You do not state any symptoms of hearing loss or other ear problems, butyou can go to an Ear, Nose and Throat physician as well to help make sure the dizzinessis not coming from your ears.

Remember "A medical professional is the only person who should make the diagnosis of panic attack. There is no such thing as a "wasted" visit to the doctor in this case. It is better to be told that the diagnosis is panic attack than to assume that someone is panicking and be proved wrong. "

You do mention that the symptoms occur monthly. If they occur around your menstrual cycle, it maybe worth while discussing this with you OBGYN as well.

Thank you doc for all the helpful information i defenitly will look into going back to my doc for some blood testi did see my gyn who acually did not see anythng phcycal wrong with me he suggested that i take birth control pills to try to control my pms wich i am not so happy about .the last time i wnt to my doc she prescribed me xanax and told me to take it when i feel a panic attack coming i did try it a few times it only made me feel like i drank a cup of wine i guess it did calm me down at that moment.but i think that you r right i should try to go see a nurologist to try to rule out any nurilogical problems.thanks agin.

hello dr. ledereich,my daughter had her hearing tested recently and although she had normal hearing, in one ear only she had hearing loss for high frequencly sounds. is this something to be concerned about? my ped said not to worry about it and the audiologist said the assymetry could signal a problem. i was just curious what you thought. thank you.

It would be worthwhile either working it up - looking for a specific cause, to make sure 1) it does not getworse, 2) it does not effect the normal ear.

It depends on what kind of hearing loss it is. Is it sensorineural? Is it conductive (as with an ear infection)? Is it just due to some wax inthe ear canal? These are subjects to discuss with your pediatrician.

If your pediatrician does not wish to work it up, at leastfollow it with serial hearing tests (every 3 - 6 months or so)or sooner if any symptoms occur, to make sure it isa stable loss and not getting worse.

It goes without saying that avoiding loud noises (acoustic trauma)will help with maximizing hearing preservation for everybody, and especiallyyour child - if there is a slight hearingi loss, an acoustic traumacan make the hearing much worse (chas vsholom!).

Hi, and thank you in advance,my questions is the following3 of my children keep having recurent strep,the oldest is 14, had tubes twice when child for ear infections, had long period of being well, past 2 years constant strep.the second one is my 8 year old daughter,also twice tubes for chronic ear infections and constant strep, tonsils were removed too....countless streps after that...my 5 year old son has had now 7 streps since this past September.I am tired of antibiotics....the 5 year year old one is not on any form of casein.None of them are carriers, according to our ped.Most of the times the strep comes with fever.I feel its an immune system problem....pandas? Are you familiar with it? Any ideas?Thanks

Hi, and thank you in advance,my questions is the following3 of my children keep having recurent strep,the oldest is 14, had tubes twice when child for ear infections, had long period of being well, past 2 years constant strep.the second one is my 8 year old daughter,also twice tubes for chronic ear infections and constant strep, tonsils were removed too....countless streps after that...my 5 year old son has had now 7 streps since this past September.I am tired of antibiotics....the 5 year year old one is not on any form of casein.None of them are carriers, according to our ped.Most of the times the strep comes with fever.I feel its an immune system problem....pandas? Are you familiar with it? Any ideas?Thanks

Without seeing them, I would like to clarify with you about the carrier status - have they been culturedat the same time while they have no fever? Is strep present or absent?People can be strep carriers, and the fever/infection from another organismis then blamed on the innocent "strep" that the person is just carrying.

Dr L, I had a question regarding paralyzed vocal chords. My husband has one that is completely paralyzed. He had some neurosurgery recently and I was permitted to read the surgeon's surgical report. His report mentioned the one paralyzed vocal chord and mentioned that the other one is "partially paralyzed". Can it stay partially paralyzed forever? Or is it probable that it will soon be just like the other one? And if it becomes completely paralyzed, does this mean that my husband will not have a voice? What happens when someone has both vocal chords paralyzed? Thanks in advance..... smileyface136

A persons vocal cords open and close in response to breathing and speaking. A personcan speak, even well, with one paralyzed vocal cord. 2 paralyzed vocal cords are more of a problem, because breathing can be impaired. A person with 2 completely paralyzed vocal cords sometimes may require a tracheotomy (a breathing tube in the neck).

There are some ways to know if the vocal cords nerves are damaged forever or justtemporarily, by doing a test called an EMG, which would help differentiate between"partial" "complete" "permanent" "temporary" vocal cord paralysis, depending on the pattern of muscle reactions that are seen.

Often temporary vocal cord paralysis can be treated expectantly, allowing it to getbetter by itself. One sided permanent vocal cord paralysis can be treated with speech therapy, and if vocal quality is not good, surgically by pushing the bad vocal cordinto the middle of the voice box. This would allow the good vocal cord to make contact with itallowing an improved vocal quality. For patients with bilateral vocal cord paralysis, in order tocome "off the traceotomy", a little bit of the vocal cords can be removed. Unfortunately, in thatsituation, the better the breathing, the worse the vocal quality.

You should feel free to discuss these issues with your family doctor.

I hope your husband has a refuah sheleima. You did not include any specifics in terms of the neurosurgical findings in your husband, as these may be important considerations in treatments.

Dr L, Thanks for your reply. Since reading your reply, I already e-mailed our neurosurgeon to request a copy of his most recent operative report. That will be a new report since surgery was just done on March 1. My husband has an Arnold Chiari Malformation and a fairly large spinal syrinx. I would like to think that the surgeon would give our PCP a heads-up on the possibility of the second cord becoming paralyzed. But I have learned NEVER to assume that the doctors have touched base on all issues. My husband has had many surgeries in the last three years and he is very difficult when it is time to intubate him. I think that is how the second cord started having trouble. Too many difficult intubations. I do thank you for the information you gave in your last reply. I had no idea that breathing could become the big issue. Again, thanks! Michele

1) Arnold Chiari is sometimes associated with obstructive sleep apnea - something to look out for. For some reason, the pressure on the brainstem causes breathing abnormalities during sleep.

2) I recently diagnosed a women with the Arnold Chiari malformation just because she had bilateral vocal cord paresis - her vocal cords were not completely paralyzed, but had decreased movement. One of the tests I did to see why her vocal cords were not working included a CT scan of her brain, where the abnormality was noted. After her surgery, her vocal cord mobility became normal.

3) Make sure if your husband has any more surgeries, that he tell the anesthesiologist that he is a difficult intubation. It may be worthwhile to have him intubated awake via a fiberoptic transnasal technique. Often the ENT doctor has to help the anesthesiologist do this.

4) It may be worthwhile to have your husband evaluated by an ENT doctor and see what the vocal cord abnormalities are, and whether they can be improved, either conservatively with speech/voice therapy, or with surgery,that can even sometimes be done with the person awake under local/sedation techniques.

Dr. L, It is refreshing to see an ENT who is pretty familiar with Chiari!!!! My husband does have obstructive sleep apnea and is on a C-PAP. He is on a very high setting. He also has Klippal Feil Syndrome (which is a mystery to me) and the doctors involved in his neurosurgeries all know that he needs to be intubated with a fiber optic scope. That was a lesson we learned after a most difficult intubation resulting in respiratory distress and then severe edema in his throat. He had already had the one parylized vocal cord even before that surgery. Seeing him on a respirator for 6 days while we waited for the steroids to bring down the swelling was enough to teach me the value of making sure EVERYONE involved in his care is reminded of ALL his minor as well as major issues. You mentioned a patient who's vocal cord mobility returned to normal after a surgery. Was that a Chiari decompression surgery she had? Or was it something else? We are waiting for him to be free from infection for a while before we let him have the decompression revision we know he needs. He had a persistent infection for over three years after his first decompression. Eventually, it left him with a chronic wound-type of infection that needed daily care for over a year and a half. The neurosurgeon wants to make sure that there is no chance of bacteria leaking to the brainstem when he goes through the dura to do the revision. So he is waiting for him to be bacteria-free for a while. He is now bacteria-free for two full months. It would be wonderful if his vocal cord problems could resolve after having a proper decompression! I would think that his vocal cord situation is only getting worse now, since I often hear purring noises when he breathes. I am still waiting to read the doctor's surgical report. Is there anything I need to warn an ENT about when I take him to one? The last time he was there, four years ago, was before we even knew he had the Chiari Malformation. THis is the healthiest he has been since then so it might be the right time to persue that avenue. I thank you!

>It is refreshing to see an ENT who is pretty familiar with Chiari!!!!Thanks for the compliment, but AC is a risk factor for sleep apnea. I have to keepup to date with lots of different diagnosis, as I am the 2nd editor of the Mount SinaiJournal of Medicine, (see http://www.mssm.edu/msjournal/editor.shtml).

>My husband does have obstructive sleep apnea and is on a C-PAP. He is on a very high setting. Great - he should use it in good health!

>He also has Klippal Feil Syndrome (which is a mystery to me) and the doctors involved in his >neurosurgeries all know that he needs to be intubated with a fiber optic scope. Good idea.

>That was a lesson we learned after a most difficult intubation resulting in respiratory distress >and then severe edema in his throat. He had already had the one parylized vocal cord even >before that surgery. Seeing him on a respirator for 6 days while we waited for the steroids to >bring down the swelling was enough to teach me the value of making sure EVERYONE >involved in his care is reminded of ALL his minor as well as major issues.Exactly.

>You mentioned a patient who's vocal cord mobility returned to normal after a surgery. Was >that a Chiari decompression surgery she had? Chiari decompression.

>We are waiting for him to be free from infection for a while before we let him have the >decompression revision we know he needs. He had a persistent infection for over three >years after his first decompression. Eventually, it left him with a chronic wound-type of >infection that needed daily care for over a year and a half. The neurosurgeon wants to make >sure that there is no chance of bacteria leaking to the brainstem when he goes through the >dura to do the revision. So he is waiting for him to be bacteria-free for a while. He is now >bacteria-free for two full months. It would be wonderful if his vocal cord problems could >resolve after having a proper decompression! It may be worthwhile to get a 2nd opionion on his neurosurgical status.

>I would think that his vocal cord situation is only getting worse now, since I often hear >purring noises when he breathes. I am still waiting to read the doctor's surgical report. It probably indicates such longstanding problems, that his vocal cord may not workagain after surgery, unfortunately.

>Is there anything I need to warn an ENT about when I take him to one? Tell them what you know.

>The last time he was there, four years ago, was before we even knew he had the Chiari >Malformation. THis is the healthiest he has been since then so it might be the right time to >persue that avenue.Good luck.

Dr L, Again, thank you! Our appointment with the PCP is at the end of May unless his old infection shows us that it is back. This is our THIRD neurosurgeon. THe first one wanted to treat a VP shunt infection with antibiotics without doing a shunt revision. My research then showed that the infected shunt should be removed and then replaced eventually. So we went to another NSG. THis second NSG accidently nikked an artery in my husband's brain during his 4th shunt revision. (that stupid infection kept coming back!) After the doctor told me about the brain hemmorage, we waited just long enough for my husband's condition to be stable before we went to our THIRD neurosurgeon. THis time we went straight to the top Chiari specialists in the country. We are lucky that we live in Philly and the top guns are in NY. Only a 2 hour ride. I know people who fly in from other countries to see these guys. IT's not that we need another neurosurgeon's opinion, now we just need the TRUE healer to cooperate. Then we will be on our way to a decompression. Do I have your permission to print your replies to my posts to show to the docs? Again, thank you, you have been very helpful. Michele

> IT's not that we need another neurosurgeon's opinion, now we just need the TRUE healer to cooperate. Then >we will be on our way to a decompression. Hashem should help your husband and all Cholim Biyisroel, bimheira biyameinu.

>Do I have your permission to print your replies to my posts to show to the docs? Again, thank you, you have been very helpful.Michele

It's been a while and since you were most helpful, I thought I should give you an update on my husband and his vocal cords. He had a posterior fossa decompression revision on Nov 17. That surgery lasted 14 hours from start to finish. Again, intubating him , even fiber optically, was very difficult. He had too much edema in his throat for them to extubate and a few days after the surgery, they even had to trach him. The trach was removed 6 weeks after surgery. He had spent that entire time in isolation at the hospital due to infections in his blood and many other compications. Communication between the ENT and I was very minimal once the trach was in. I was very unhappy about the need for the trach so I was probably not someone the doctor wanted speak to much. Whenever I asked about the status of his vocal cords, I was told that only a scope would give those answers and they did not want to scope him. THe trach was pulled out the day before he was released from a rehab facility and I was again given no advice or info from the doc. THe nurse showed me how to dress the area until the hole closed. So I imagine that no doctor bothered to check anything with his vocal cords. To my layman's eyes and ears, his vocal cords are exactly the same as they were before this last surgery. We now know that in the future, he will be trached before any surgery. (Although my husband is refusing to have any more surgeries unless he is in an emergency situation) So that is where we stand. Thanks for all the information you gave me before.

I have a son with speech delays. Although his language is improving his speech is very unclear. his speech therapist says his voice sounds very nasally. Also he always snores at night. I took him to an ENT who checked and said nothing wrong with adenoids, but that my son has reflux. He was put on a medication that is helping the reflux but now that the reflux has cleared his voice is still nasally and he still snores. My doctor has no answers for that. What do you suggest?

It really depends on the size of the adenoids, the palate function, the nose/sinus findings. For example if the adenoids are large, thatcould be addressed. The same if there is a sinus infection.Speech therapy is helpful. A good physical examination is helpful.A second opinion is also helpful as well.

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